Aging in Canada: How well are we treating our elders?

What do you think of when we talk about seniors? Do you think of someone who is rich with life experience, perhaps a grandparent, working hard in the community to share his or her expertise and wisdom with younger generations? Do you think of a poor, helpless old man or woman, isolated and unable to leave their house?

And how do you view the seniors in your own life? For those with relatives who have dementia, they may or may not recognize you. Do you still spend time with them? Or do you withdraw from them and convince yourself that they wouldn’t appreciate your visit?

The way we view seniors – the degree to which we admire their contributions and value their insight – may well inform the way we treat them. It affects how much we turn to them, how much time we spend with them, or whether we avoid doing so.

According to Greg Shaw, who heads up the International Federation on Ageing (IFA), ageism is widespread in Canada – and a lot of it is rooted in a range of misconceptions many Canadians share about older people.

A growing demographic – and a skewed impression

We often hear about how Canada’s experiencing a dramatic demographic shift as the Baby Boomers reach retirement age. This change, along with rising life expectancy, means that more people are reaching old age – and those that do are living longer. According to the World Health Organization, life expectancy for Canadian men is now 80, while for women, it’s 84. There were nearly five million Canadians aged 65 or older in the 2011 Census, while the 60-64 age bracket was the fastest-growing.

At the same time, ageist attitudes remain common. A 2013 report on ageism from the IFA and Revera illustrates just how widespread they are. 63 per cent of seniors aged 66 or older said they had been treated differently because of their age, while a third of all respondents admitted to having treated someone differently because of their age. Among Gen X and Y respondents, the number was 43 and 42 per cent, respectively. Over one in five respondents, furthermore, said they believed older Canadians were a burden on society.

These attitudes can manifest themselves in a variety of ways, whether it’s dismissive behaviour from health care professionals, government programs that don’t take their needs into account, or facing assumptions that they’re either incompetent or have nothing to contribute.

All of these attitudes, says Shaw, reflect an inaccurate view of seniors – and may say more about the respondents’ own anxieties than about older people themselves.

“I think for many people, they fear getting older,” he says. “And I don’t think it’s so much a fear of getting older as much as a fear of losing brain function, losing mobility, losing independence. So [they] think of someone who is older and frailer that isn’t able to get out and about and interact with the community, who is isolated at home without a lot of physical contact with people.

“And that’s the view that many people see. But it’s not reality when you consider how many people live healthy and productive lives.”

Shaw points out, for instance, that only seven or eight per cent of seniors live in long-term care facilities – and even among that small amount, many probably would probably be living at home if they had access to adequate home care.

How well are we caring for them?

Do these negative attitudes affect the quality of care they receive? Not likely, says Dr. Michael Gordon, a geriatrician at Baycrest Health Sciences in Toronto. He believes people are for the most part getting the care they need, despite some logistical and economic challenges along the way.

“I think Canada in general has improved enormously in terms of the thoughtfulness and the programs and the respect that goes into elder care, he says. “That does not mean it has achieved all its goals. And we can always find deficiencies and holes and things that can be improved, and that’s part of the iterative process.”

Shaw argues, however, that older people in Canada are likely too quick to be institutionalized: many who are living in long-term care facilities, in other words, would be equally well-served (if not better served) if they were able to stay at home with the aid of a personal support worker. Canada, he points out, still places a heavy emphasis on long-term care as bricks-and-mortar facilities, rather than providing a more robust, publicly-funded home care system.

“When I’ve looked across long-term care homes across Canada,” says Shaw, “there’s a reasonable percentage of people currently in long-term care who could be supported at home if there was broad homecare funded programs. And there’s not.”

Dr. Gordon points out that there are plenty of homecare services available, but only some of it is covered by public insurance – and in Canada, the extent of that coverage depends on the province or municipality where you live.

“Let’s assume that most people want to stay at home for as long as they can with help, he says. “They can get some help, but some of the help they need is not covered by any government resource. So that’s private health. If you don’t have the wherewithal for that, you don’t have a family, you can’t do it.”

It’s a similar situation with institutional care. While nursing home care, chronic care or palliative care are typically covered, assisted living is not.

Barriers to understanding

Still, as Dr. Gordon suggests, a lot of the quality of care individuals receive depends on the dedication of their families. How willing are they to help their parents, grandparents, aunts and uncles? Is there a problem of neglect? He doesn’t think so.

“I think the public has become more and more aware as have our aging parents,” he says. “Once it becomes personal, you become aware of what the good parts are and what the deficiencies are.”

Still, there can be barriers to understanding when it comes to caring for and visiting older people. Families with a loved one suffering from advanced Alzheimer’s or dementia, for instance, or who has suffered a stroke and is unable to communicate, may find it harder to bring themselves to pay regular visits, much less know what to do when they’re there.

Dr. Gordon acknowledges the challenge these situations present to family and caregivers. “It’s very hard for a person to visit someone who’s not communicating, or sometimes has behaviour problems and is agitated, or who is bringing up old issues and acting angrily,” he says.

But, he adds, there has to be a greater understanding here. “You have to realize when you’re visiting somebody: it’s not for you; it’s for them.”

Overcoming these attitudes

As Dr. Gordon pointed out, our attitudes towards our elders tend to improve considerably the more personal it becomes. And this has changed things on a broader scale as the Canadian population has gotten older and people live longer. But obviously, many of these attitudes persist.

One particular barrier – more than any anxieties about aging and death – is a perceived inability to know what to say when visiting an older relative who is sick or dying.

“I do palliative care,” says Dr. Gordon. “And there are people who say, ‘I can’t visit a person because I don’t know what we’re going to talk about.’

“A lot of people have this idea that if you’re visiting someone who is dying, you go in and you have to say, “how are you feeling?” Which of course is a terrible thing to say to someone in that state. And the thing that’s interesting is that most people in that state want to talk about ordinary things.”

Shaw reminds us, however, that most seniors aren’t sick or dying, or even in long-term care. The vast majority are living healthy, fulfilling lives. The focus, then, should be more on recognizing not only what they’ve achieved in the past, but also what they continue to contribute well past retirement.

“It’s easy to think about Mrs. Smith who lives next door, who’s isolated and really frail and can’t get out of the house,” says Shaw. “And that’s the view that one has. So how do you change that view?”

One answer, according to Shaw, is to bring generations together in shared activities. His organization’s Age Is More campaign brought kids together with seniors to spend time together, share in activities and learn about each other, with the goal of challenging many of the preconceived notions that younger generations have about older ones.

“We commissioned about 16 short videos of these young kids working with seniors living in long-term retirement facilities,” he says.

“But the thing for me was the attitude that the kids had after they completed working with the seniors. They said, ‘They’re just normal people, just like us.'”